4/28/2014. Reena Patel, OD, FAAO. 5 to 10% of all preschool-aged children. Myopia. Hyperopia. Astigmatism. High refractive error

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1 5 to 10% of all preschool-aged children o Significant refractive error o Amblyopia Poor vision Reena Patel, OD, FAAO Misalignment of the eyes Myopia o nearsightedness Hyperopia o farsightedness Inward eye turn Astigmatism Outward eye turn High refractive error Visual deprivation Majority of human learning occurs visually Vision impairments more than just poor vision o Emotional development o Neurological development o Physical development 1

2 Done to detect children who have or are at a risk for having visual impairments o Significant refractive error o Amblyopia Early screening/detection and treatment = very important Children at risk for vision impairments Comprehensive eye examination Screenings versus Comprehensive eye examination o Very common myth: They are both the same thing. Which children are considered to be at risk.? Neurodevelopmental disorders Readily recognized eye abnormalities Born premature Maternal smoking, drug, alcohol use Family history of eye disorders Suspected to have an eye disorder Difficult to screen Refractive Error o Contact lenses o Prisms o Vision Therapy o Surgery Amblyopia o Patching o Eye drops 2

3 Visual impairment affects their learning ability In addition, may have difficulty with: o Speech o Motor o Hearing o Cognition Early identification and intervention is critical Brain maldevelopment characterized by motor dysfunction o *Amblyopia o Poor eye focusing skills o Poor eye tracking skills Chromosomal abnormality cognitive delays o *Amblyopia o Poor eye focusing skills o Blepharitis/conjunctivitis Genetic risk and environmental factors o Poor eye tracking skills Genetic risk and environmental factors o Poor eye teaming skills Convergence Insufficiency may be mislabeled as ADHD o Esotropia Inward eye turn o Exotropia Outward eye turn o Hypertropia Vertical misalignment Ptosis o Droopy eye lid 3

4 Leukocoria ( white pupil ) o Uncorrected refractive error o Congenital cataract o Retinopathy of Prematurity o Coat s disease o Retinoblastoma Born prematurely o <32 weeks of gestation o Low birth weight (<1500 grams = 3 lbs, 4 ounces) o At risk for retinopathy of prematurity Maternal smoking, drug or alcohol use during pregnancy Family history of eye disorders Complains about: o Blurry vision o Double vision o Headaches with near work Squinting Rubs eyes Avoids reading Holds reading material very close Sits close to the TV Bumps into things Behavioral issues or refuses to do something Something we can all relate to Early detection and treatment is extremely critical Importance of follow up care Teamwork is key!! 4

5 1. Calonge N. Screening for visual impairment in children younger than age 5 years: Recommendation Statement. Ann Fam Med. 2004;2: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. Vision impairment among children. Available at: Visionimpairment.pdf. Accessed August 23, Black, P. Visual disorders associated with cerebral palsy. Br J Ophthalmal. 1982;66: Merrick J, Koslowe K. Refractive errors and visual anomalies in Down syndrome. Downs Syndr Res and Pract. 2001;6(3): Reena Patel, OD, FAAO; rpatel@ketchum.edu 5. Denis D, Burillon C, Livet MO, Burguiere O. Ophthalmic signs in children with autism. J Fr Ophthalmol. 1997;20(2): Granet DB, Gomi CF, Ventura R, Miller-Scholte A. The relationship between convergence insufficiency and ADHD. Strabismus. 2005;13(4): The Vision in Preschoolers Study Group (2007). Children unable to perform screening tests in Vision in Preschoolers Study: Proportion with ocular conditions and impact on measures of test accuracy. Invest Ophthal Vis Sci, 48(1):